Diagnostic approach to Helicobacter pylori-related gastric oncogenesis

Abstract

Helicobacter pylori ( H. pylori ) is a causative agent of peptic ulcer disease and plays an important role in the development of various other upper and lower gastrointestinal tract and systemic diseases; in addition to carcinogenesis and the development of mucosa-associated lymphoid tissue lymphoma, extragastric manifestations of H. pylori are increasingly being unraveled. Therefore, prompt and accurate diagnosis is essential. Within this narrative review we present an overview of the current trend in the diagnosis of H. pylori infection and its potential oncogenic sequelae, including gastric mucosa atrophy, intestinal metaplasia, dysplasia and gastric cancer. Signs of H. pylori -related gastric cancer risk can be assessed by endoscopy using the Kyoto classification score. New technology, such as optical or digital chromoendoscopy, improves diagnostic accuracy and provides information regarding H. pylori -related gastric preneoplastic and malignant lesions. In addition, a rapid urease test or histological examination should be performed, as these offer a high diagnostic sensitivity; both are also useful for the diagnosis of sequelae including gastric and colon neoplasms. Culture is necessary for resistance testing and detecting H. pylori -related gastric dysbiosis involved in gastric oncogenesis. Likewise, molecular methods can be utilized for resistance testing and detecting H. pylori -related gastric cancer development and progression. Noninvasive tests, such as the urea breath and stool antigen tests, can also be implemented; these are also suitable for monitoring eradication success and possibly for detecting H. pylori -related gastric malignancy. Serological tests may help to exclude infection in specific populations and detect gastric and colon cancers. Finally, there are emerging potential diagnostic biomarkers for H. pylori -related gastric cancer.

Association between Helicobacter pylori Infection and Nasal Polyps: A Systematic Review and Meta-Analysis

“…In this regard, histology has been repeatedly demonstrated as the practical diagnostic gold standard for detection of H. pylori [ 1 , 54 ]. IHC in particular yields an excellent sensitivity and specificity, reaching almost 100% [ 7 ]. Of special interest is the ability of IHC to detect the coccoid form of H. pylori, which forms for instance after proton pump inhibitor (PPI) treatment, where the conventional histology may be challenging in detecting the “disguised” microorganisms [ 55 ].…”

“…Up to 3% of patients with clinical symptoms of H. pylori infection may develop gastric cancer [ 4 ], with over 1 million new cases of gastric cancer and nearly 800,000 deaths occurring in 2020, thereby making H. pylori -related gastric cancer the third leading cause of global cancer deaths [ 5 ]. Beyond the local well-established virulence of H. pylori, multiple extra-gastric manifestations have been attributed to H. pylori infection [ 3 , 6 , 7 ]. These manifestations include hematological, cardiovascular, respiratory, neurological, ophthalmic and metabolic syndrome-related disorders and other non-gastric neoplasms [ 3 , 8 , 9 , 10 , 11 , 12 ].…”

Impact of Helicobacter pylori and metabolic syndrome-related mast cell activation on cardiovascular diseases

“…Recognizing that H. pylori infection may exacerbate the pro-inflammatory milieu in these patients, clinicians can consider routine testing for the presence of the bacterium. Although gastric histology for the detection of H. pylori represents the practical diagnostic gold standard for active H. pylori infection (197), noninvasive tests, such as the urea breath test or stool antigen test, can identify H. pylori infection with high sensitivity and specificity (197). In high-risk populations, such as those with MetS, routine screening may provide valuable insights into a patient's overall risk profile.…”